Dr. Eric Westman: Hi, I’m Dr. Eric Westman and it’s my great pleasure to introduce Dr. Vera Tarman. Dr. Tarman is the Medical Director of one of Canada’s largest treatment centers for substance abuse. She is an internationally renowned expert on sugar and food addiction and is the author of Food Junkies: Recovery from Food Addiction.
Additionally, she co-hosts the Food Junkies podcast, where we first met, and runs educational workshops. She is a featured speaker at conferences and a highly respected authority on diagnosing and treating food addiction. Moreover, Dr. Tarman has lived the food addiction experience: she’s a recovering food addict – aren’t we all?! She has maintained a 100-pound weight loss for more than 12 years. Welcome and thank you so much for talking with me today.
Dr. Vera Tarman: Thank you. I’m delighted too.
Dr. Eric Westman: How did you first get interested in addiction medicine and then food addiction specifically?
Dr. Vera Tarman: I live in downtown Toronto so it’s a really urban center and it was right in the heart of the gay community. I was doing a lot of HIV work and that was very intense. When that got resolved with the medications, I was really reluctant to go back into family medicine which was just not intense. After such intensity, I found it quite boring, I’m sorry to say! The other thing that was really prevalent in downtown Toronto – or any urban center – was addiction. I just got drawn into the addiction world and I did very well in that world. I come from a family with addiction so it was like, “I can handle this, no problem.” In that world, I started to see patterns of behavior that I recognized in myself. My own personal story is that I had my own issue – like probably 80 percent of women in college years – with my weight and with food. I really struggled with that and I got myself caught in a real bind. Now, in hindsight, this was in the 1970s and we had no words like “food addiction,” but we did have words beginning, like “eating disorders.” I would have said that was classic bulimic and binge eating disorder behavior. I didn’t know that then, and I really struggled with that. That paralleled with my addiction interest and I started to see behavior that I saw in alcoholics and addicts. I was doing the same thing!
I started to read more about it and came across people like Dr. Nicole Avena, who’s a well-known spokesperson in the addiction field, specifically about food addiction. I thought, “I’m not making this up. It’s not crazy. There is actually science behind this.” Once I saw that and acknowledged that, I didn’t have to be convinced – I had my own personal story. It made so much sense. Then, I started to see it in my patients over and over and over again. People would come in, stop the alcohol, stop the cocaine, because they weren’t allowed to do it, but we would let them eat and they would eat and they would say, “I don’t know why I’m eating this much.” I thought to myself, “I know why.” Then I started speaking about it. I made it my own professional side interest, which is where I am today.
Dr. Eric Westman: Fantastic. Are there a few hallmark signs of food addiction?
Dr. Vera Tarman: To some degree, I think we all are in the early stages of food addiction, just by virtue of eating the toxic food that we eat, which is mainly processed refined carbs and sugar. I think we all have some level of addiction or addictive behavior, but it depends on how much you’re focused on food that you actually become more, what we would call not just somebody who’s eating addictively, but who actually has an addiction.
Signs that we would look for include: does the person have cravings that become obsessive? It’s not just, “I crave a little bit of ice cream,” but rather, “I’ve got to have that ice cream or I won’t be able to sleep tonight.” Just like the alcoholic needs that bottle of wine to get to sleep, this person needs refined sugar – it’s either a favorite ice cream or cake or something. We focus on obsession. Usually, at some point, a person realizes, “Oh my gosh, I’m starting to gain weight,” or “I’m pre-diabetic and I should really cut down.” Then, they find that they can’t cut down or they might have already tried to not have the whole cake – just a piece – and they find that they can’t. To those listening, are you thinking, “Do I obsess and put a lot of mental real estate into my food? Even as I am doing something else, am I thinking in the background, “I want to eat this,” or “I better have it tonight”? Do you struggle with having just a couple of Oreo cookies, or do you have the whole bag? Are you having issues with your eating behavior – are you already becoming pre-diabetic or diabetic or gaining too much weight? There’s actually an impairment happening. If you’re getting into trouble and you still can’t control it, there’s already a hallmark sign.
The final thing I would ask is, when you stop – if you’ve ever tried to stop – do you find that you can’t? You just can’t because if you do, you won’t sleep and all you’ll think about is food. If you’ve become dependent on it, then we say that’s looking like an addiction now, not just eating addictively, like having a few more than you should. You’re actually gripped by the food; it’s become a dominant force.
Dr. Eric Westman: I may have a selection bias due to the fact that people who come to my office are usually looking for diabetes reversal or weight loss, but this is almost everyone who comes to my office. Is it that common in the general population?
Dr. Vera Tarman: This is a really interesting question: what’s the prevalence of food addiction? It’s an interesting question, because clinicians – except for enlightened people like Dr. Nicole Avina and Dr. Robert Lustig and those of us in the trenches who are trying to make this an issue – the general medical world still doesn’t want to acknowledge this. They just don’t want to think that this is a condition. Because of that, it’s very hard to get research because you have to have a syndrome. You have to have a diagnosis in order to do research. There have been some estimations and it can be anywhere from the normal overall population, probably between five and ten percent, which is similar to alcoholism. But if you look at specific groups, like the obese population – people with a BMI of over 30 – it could be as high as 40 percent, so it’s quite high. Unfortunately, it’s a huge range – anywhere from 10 to 40 to 50 percent, but that’s a lot of people. Obviously, the people who are having the consequences are going to your office and my office, and they’re probably at least 60 percent.
Dr. Eric Westman: I remember there was some work done at Yale on food addiction. They looked at the prevalence of bariatric surgery populations and diabetes. It’s very high, which makes sense. I blame the food, not the person. Some people say, “There can’t be food addiction! You have to eat, right?” Why is there really food addiction?
Dr. Vera Tarman: You and I know that when somebody says, “Well, I have to eat,” the answer is going to be, “Yes, of course, you have to eat, but you don’t have to eat that stuff!” You don’t have to eat refined, processed foods. That’s exactly why you propose the low-carb diet; that’s exactly why it works – because you’re knocking all that stuff out. Of course, the alcoholic needs to drink, but they can drink water; they don’t have to drink alcohol. Sugar is the food person’s alcohol. You don’t have to eat sugar or refined foods, and there are a lot of foods without that. You can eat plenty without eating that stuff.
Dr. Eric Westman: I have a lot of people who come to me, they get onto our simple system of a low-carb diet – it’s a sheet of paper with foods they can eat – and they do great. They sail through. They say it’s the easiest thing they’ve ever done, and cravings go away after a day or two. I don’t have a great percentage but it may be 50. The other 50 percent come back and they’re struggling left and right, they’re falling off the plan, and they’re adding back carbs. Why is it difficult for some people? What are the most common things you think about when someone has trouble staying away from the foods that are addictive, like refined sugars and starches?
Dr. Vera Tarman: This is where I say that the Paleo and the keto and the low-carb world have really got it in the sense that they found the food addiction gold standard, which is to quit processed foods and quit sugars. The reason why the diet works so well is that the person is addressing hormonal irregularities, like the insulin profile, which gets altered. But they don’t realize that it’s also a mental thing. This is the missing piece of the puzzle. We also need to acknowledge that you have inadvertently stumbled upon the solution, which is to remove the trigger food and then, like you said, the cravings are gone. My experience is that for some people it takes more than a few days. Not terribly long, maybe ten days to two weeks.
Some people are more sensitive to carbs than others. The processed food industry has wheedled its way even into the keto world. ‘Keto foods’ are little fat bombs; they are little ways to trip somebody up. Not everybody will get tripped up, but the 60 or 40 percent that is super-sensitive will. Your person that comes in and says, ‘’I’m struggling,” they’re first of all going to take longer than a couple of days because they’ve come in already more addicted, they have more on their plate to fight. If they’re not quite clean with the carbs it’s like you’re trying to quit smoking but you’re having a few puffs here and there – you just prolong the agony. That’s not going to work. The agony becomes so bad that people say it’s impossible. It’s only impossible for 10 days, or however long until you stop, and then it’s possible. If you keep having a little bit here and there, sneaking in, and then getting those processed keto treats, then it becomes impossible. It’s hard and you can’t make that hard last too long. That’s what’s happening. I think some people are just more predisposed, just like some people are more diabetic; their level of disease is more advanced and so they really need to be clean.
Sometimes, when you take the addiction framework, which is what I’m trying to suggest that people do, you may need to do more than just the diet. You may need to get structural support. It might be that a person can’t have certain foods that are acceptable on a keto plan because it’s become a trigger. They have to put on the addiction glasses and realize sugar and refined carbs are the first things, but there might be more. Dairy might be a problem, cheese might be a problem, nuts might – we have got to get rid of a lot of that stuff if they’re further advanced.
When I hear somebody say, “I’m doing it right, why am I still struggling?” I’m thinking, “Because there’s still something that’s triggering you.” It shouldn’t be that hard.
Dr. Eric Westman: That’s been my experience, too. It even reminds me of the days of alcohol detox centers where you could just check yourself in for 30 days. Those came and went. The final studies were done showing it didn’t help on average, but that’s where I learned how to do obesity medicine – it was here with programs in Durham, North Carolina, that Duke had at the time. I saw that struggle and some people literally did have to remove themselves and come to a safe place like a detox program. Are there places you can go to for food detox?
Dr. Vera Tarman: This is the thing – if we don’t get the diagnosis, we won’t get the insurance and we won’t get the funding. This is the killer. I work in a treatment center where it’s drugs and alcohol. We lock the person up for a week or a month and they walk out basically having gotten rid of that. They’ve gotten through that horrible withdrawal. For a while, we actually had a wonderful person who donated enough that we could do a food addiction program for two years. The same thing happened – we locked those people up and they were screaming in those first two or three days saying, “I can’t sleep! What am I going to do without my carbs?!” And then by the end, when they left, they were saying, “Ah, it’s done, it’s finished,” and it was a great success. The donations ended and that was the end of it. We need something like that.
What we do have – I do want to give hope here – we do have a number of virtual programs now, thanks to COVID, that people can go to, especially in the U.S., that will try to accommodate that. It’s the best we’ve got.
Dr. Eric Westman: What I’m hearing and what my impression is, is that you may need help if you can’t do this on your own. There are trained specialists who can help you out. I use the metaphor of learning to ride a bike. If you have ever helped someone learn to ride a bike, usually it’s a child, they may fall over and if it’s not a bruised knee it’s a bruised ego. Persisting is important and there’s a learning curve. Once the child learns to ride the bike, I’ll never forget that look in the eye of, “I don’t need you anymore,” and they’re off! A lot of what I do is just that support of, “Yes, there is hope and there’s help.” That’s the message that you’re giving too, isn’t it?
Dr. Vera Tarman: Yes. Even though we don’t have an official diagnosis yet, this is coming up from the underground. More and more people who are trained are now offering decent food addiction services on that level of support and education. That’s very heartening. This is actually the time. We are at the cusp of this and I hope that the funding and clinical world takes it on after this, once they see that we’re actually doing something useful.
I want to throw in a message of hope, if I may. I want to say to people if there’s anybody here thinking, “Okay, maybe I’ve got a problem,” the reality is that there are hundreds of people – we don’t see them because they’re in the trenches – hundreds of people who have managed to beat this addiction in the sense that you always have the addiction but you’ve managed to live in such a way that the foods you should eat, you love. As long as you avoid the ones that are triggering, there’s no struggle anymore. You’re going to love the food that you’re eating and you’re going to maintain your weight loss and be diabetes-free forever! Not just for a year and then relapse. There is a possibility and there are a lot of people out there, we’ve just got to have their voices heard. It really is possible, and I can attest to it because I’ve seen it in myself and I’ve seen it in many, many patients.
Check out the full video here.